Minimally invasive management of hallux rigidus

Abstract

The hallux rigidus is a degenerative osteoarthritis of the first metatarsophalangeal (MTP) joint, considered the most common arthritic condition in the foot. On clinical examination, an MTP joint of the hallux that is larger than normal may be encountered, and the interphalangeal joint is hyperextended, with a plantar callus at the base of the distal phalanx. Palpation elicits dorsal tenderness, crepitus, and limited mobility, and we can support our clinical findings in patients with imaging methods, helping us in the accuracy of the diagnosis and the preoperative planning if necessary. The aim of treatment is to decrease the local inflammatory process and help to decrease the extension forces of the metatarsophalangeal joint. Initially all patients are treated with nonoperative treatment, although some of them will need operative treatment. Hallux rigidus surgical treatment has been somewhat controversial, with many different surgical treatments described to date, which can be divided into two groups in relation to the treatment of the MTP joint: destructive and preserving. The choice of the procedure still is an individual decision of the treating surgeon, and nowadays percutaneous osteotomy has proven to be a valid technique that yields results similar to open osteotomy for the treatment of forefoot problems. In this chapter, we describe our minimally invasive technique for hallux rigidus surgical treatment.